Project Snapshot – Sustaining improvements in the management of infants with bronchiolitis – a PREDICT study

The PREDICT ‘Knowledge Translation in Australasian Paediatric Acute Care’ (PREDICT KT study) (HREC/16/RC), a multicentred, cluster, randomised control trial of infants with Bronchiolitis, demonstrated that use of targeted, theory-informed interventions (clinical leads, stakeholder meeting, train-the-trainer workshop, targeted educational package, audit/feedback) significantly improved compliance with five key non-evidence-based practice recommendations for bronchiolitis (chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline) in acute care settings by 14.1% (adjusted risk difference, 95% CI, 6.5%-21.7%; P < .001).

The aim of this study is to assess sustainability of improvements in reducing inappropriate therapies in infants with Bronchiolitis, at the 26 sites which participated in the PREDICT KT Study, one (2018) and two year (2019) post implementation of intervention. A retrospective medical audit and qualitative semi-structured interviews will be conducted at each site over two years following initial implementation of the KT Study interventions. Our results will help determine the sustainability of this intervention over time, determine any improvements in control group hospitals, examine the learning and decay effects of the intervention, determine fidelity and adaptation of the intervention and explore factors which may have contributed to sustained improvements in either intervention or control group sites.

Link to further project details

News:
  • Ethics approval has been received for Australian sites and provisional ethics approval has been received for New Zealand sites.
  • Sites will only be recruited if they participated in the PREDICT KT Study. Currently, 16 of the 20 Australian sites have agreed to participate.
  • Governance approvals are underway for the 16 Australian sites, with hopes to commence recruitment at these within the first half of 2022.
  • A protocol manuscript has been drafted and will be submitted for publication soon.

 

Project Snapshot – KIDS THRIVE

Trans-nasal Humidified Rapid-Insufflation Ventilatory Exchange in Children Requiring Emergent Intubation

AIM:

The aim of this study is to assess the effect of THRIVE as a method for prolonging apnoeic oxygenation during the emergency intubation of children to reduce the proportion adverse events (specifically, oxygen desaturation) and increase the proportion of first attempt success for endotracheal intubation.

RECRUITMENT STATS AS @ 24/2/22:

Study commenced 09/05/2018

  • Sample size: 960
  • Current Overall Enrolment Total: 820

Sites currently recruiting as @ 24/2/22

  • Queensland Children’s Hospital – ED & PICU
  • Children’s Hospital at Westmead – PICU
  • Gold Coast University Hospital – ED & PICU
  • Monash Children’s Hospital – ED & PICU
  • Perth Children’s Hospital – PICU
  • Royal Children’s Hospital, Melbourne – PICU & NICU
  • Townsville Hospital – ED & PICU
  • Women’s and Children’s Hospital PICU
  • University Children’s Hospital Zurich – PICU

Planned to start recruitment in 2022

  • BC Children’s Hospital Vancouver – PICU
NEWS:

2,191 children have been screen for inclusion into the KIDS THRIVE study and to date 820 have been randomised and consented. Of the enrolled children approximately 11% have been intubated in the ED, 80% in the PICU and 9% in the NICU. This study has been approved for consent to continue (delayed consent) due to the emergent nature of intubations. The Kids THRIVE Trial Steering Committee (TSC) have had complex ongoing discussions regarding the COVID-19 pandemic and the disease in children; and recommended the study not be paused and that sites be allowed to develop their own local plan on how to manage the recruitment of patients. In 2020 a systematic, prioritized, risk-based approach to monitoring the KIDS THRIVE project was undertaken and centralised in depth source documentation verification and monitoring of the trial is well underway. Our most exciting news is that The Kinderspital Children’s Hospital in Zurich recruited their first patient on valentine’s day this year and we welcome them to the study team. We anticipate finishing recruitment at the end of the year.

The KIDS THRIVE study gratefully received initial seed funding from the Emergency Medicine Foundation, and additional funding from the Thrasher Research Fund and the National Health and Medical Research Council.

Involving Consumers in your Research – Article 1: Recruitment

Involving Consumers in your Research

Over the next few months Cate Wilson, Simon Craig, Marietta John-White and other project leads will contribute a series of articles outlining how we have involved consumers in the Million Minds research program, what we have learned and how we might improve things in the future.

Article 1: Recruiting a consumer advisor group for the Kids are not OK

Background….

When the “Kids are not Ok” program of research was funded by the Medical Research Futures Fund, we felt that it would be critical to get consumer advisors involved in the development, design and ongoing roll-out of the research for the 5 key project areas:

(1) Delphi Study – An email survey of staff, patients, carers and relevant community services eg. police, school counsellors. to prioritise research questions and agree on core outcome measures for future studies.

(2) Retrospective Study – A review of medical records

(3) Prospective Observational Study – Enrolment in the ED and follow-up for 12 months

(4) Safety Planning for Suicidality – We planned to conduct a trial of a safety planning program supported by an app and telephone support for patients who present to the Emergency Department at risk of suicidal crisis.

(5) Treatment for acute severe behavioural disturbance: which are the best medications? Randomised clinical trials of oral and IM medications

What came next….

We developed a flyer to assist with recruitment which outlined:

  • what the program of research aimed to do
  • what our consumer advisors would be asked to do
  • what skills or experience would be helpful
  • what the time commitment would likely be
  • where meetings would be held (all changed since COVID!)
  • what financial support would be offered ($50 per hour)
  • how to apply/express interest

How did recruitment work….

  • Initially, we asked a range of clinicians in different types of clinics/ward areas where children with a range of mental health conditions were seen, to approach potentially suitable people i.e. Parents or youth of 18 years plus.  Prior to this, we had met with the clinicians to explain what we wanted and to equip them with the flyers.  Then we kept in touch to see if they had approached anyone.
  • Response was slow but after 4 weeks we had a carer consultant refer us a potential consumer.  Two of us met with our first consumer in the hospital café and we had a casual chat to explain more about the role, answer questions and generally assess that we both understood each other.  It went well and after the meeting we offered the position formally via an email and it was accepted.
  • We had not received any other referrals from the clinicians – so we asked our first consumer about how we might recruit some others?  This was a stroke of genius as she put the word out to other people and on closed facebook groups which we otherwise would not have had access to.
  • More consumers approached us and again we did coffee (pre-COVID times!) or talked over the phone.  We recruited three more people into our consumer advisory group who provided a range of experiences and skills.
  • There were a couple of people who approached us but did not meet our requirements in terms of experience (of MH), or they later felt they could not commit.

Preparation and training….

Our organization required our consumers to complete a confidentiality agreement.  We also explained the confidentiality agreement to them and they were happy to comply.

We got the group together for face-to-face training (when this was possible) and in a 1 hour meeting we covered the following:

  • description of the funded projects
  • how Consumer Advisors would contribute
  • research ethics and good clinical practice basics
  • how to contribute effectively in meetings
  • how to review documents such as PICFs
  • developing a brief summary of your story that you are comfortable to share
  • remuneration process
  • what to do if there are problems or concerns/who to go to
  • any other questions

Some links and pdfs were also provided to support the above topics.

The consumers were remunerated for their participation in training.

Since then…..

  • We contact the group when we want their involvement in specific projects.
  • We do a yearly newsletter for the consumer group that outlines progress of the whole research program.
  • We have asked each member to complete a confidential, brief survey to evaluate how they are experiencing their involvement in the research.

What we learned about setting up a consumer advisor group….

  • It takes time – ideally start when you are thinking about the grant and get input to your aims, indicators and research priorities too!
  • Consumers are fantastic at recruiting other like-minded consumers!
  • Try and recruit at least 4 – 6 people as often 1 or 2 people can’t make it to a specific meeting.
  • Ensure you budget adequately for remuneration in your grant.

Implementation Research Workshop – 31st March 2022

This one-day, online event scheduled for 31st March 2022 will address implementation research in the PREDICT network – what is implementation research, what have we achieved and where are we heading?

Dr Emma Tavender, the PREDICT Knowledge Translation Co-ordinator, together with local and international implementation science researchers will present sessions throughout the day, concluding with small group discussions.

Topics include: introduction to implementation science, future directions in implementation research (external case studies) and planning for future PREDICT implementation research projects.

This promises to be an interesting and informative day for our PREDICT members.

Bookings are now closed for this event however if you haven’t registered and feel this workshop is of particular interest to you please email marian.chandler@mcri.edu.au.

New PREDICT publications

Congratulations to the following PREDICT authors:

Pfeiffer CK, Smith K, Bernard S, Dalziel SR, Hearps S, Geis T, Kabesch M, Babl FE; PREDICT Network. Prehospital benzodiazepine use and need for respiratory support in paediatric seizures. Emerg Med J. 2022 Jan 25:emermed-2021-211735. doi: 10.1136/emermed-2021-211735. Epub ahead of print. PMID: 35078857. 

Pfeiffer CK, Mackay MT, Long E, Stephens D, Dalziel SR, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT).  Parenteral Long-Acting Antiseizure Medications Are Used More Often to Treat Seizure Clusters Than Convulsive Status Epilepticus in the Pediatric Emergency Department. J Child Neurol. 2022 Feb 10:8830738221077751. doi: 10.1177/08830738221077751. Online ahead of print.PMID: 35142572.

Barrett MJ, Dalziel S, Lyttle M, O’Sullivan R and the Pedatric Emergency Research Networks (PERN). A bibliographic analysis of global pediatric emergency medicine research networks. Pediatric Emergency Care. Dec 2021.

 

Getting to know you – meet Angie Nguyen Vu

Our “Getting to Know You” segment ensures PREDICT members are aware of new members, their interests and areas of expertise and where they are located.

This month we introduce Angie Nguyen Vu from EMF in Brisbane.  Welcome to PREDICT Angie.

“I’m Research Manager at the Emergency Medicine Foundation (EMF) based in Brisbane. EMF is a not-for-profit organisation dedicated to funding innovative, evidence-based emergency medicine research. Since 2008, EMF has distributed $18m of funding to emergency medicine research projects, including to the Queensland sites of various PREDICT projects, e.g. APHIRST, Paris I and Paris II, Bells Palsy and SONIC.

Paediatric emergency medicine has long been a major focus of EMF funded research, and I look forward to hearing more about current and future PREDICT projects. EMF is also committed to research capacity building for all emergency healthcare clinicians. Please get in touch if you would like to find out more about EMF via email to angie.nguyenvu@emfoundation.org.au.”

Getting to know you – meet Tim Robertson

Our “Getting to Know You” segment ensures PREDICT members are aware of new members, their interests and areas of expertise and where they are located.

This month we introduce Tim Robertson from Perth Children’s Hospital.  Welcome to PREDICT Tim.

“I am a paediatric registrar completing my training at the Perth Children’s Hospital in Western Australia. I have been very fortunate to spend a significant part of my training in the emergency department at PCH and as such, have become extremely interested in the ongoing research being completed by the PREDICT team. I have a keen interest in quality improvement, leading to myself becoming a part of the knowledge translation research team to help improve maintaining standards and optimizing best practice.”

PREDICT Executive – vacancy for Research Assistant

We have a vacancy for a one year period initially (2022) for the Research Assistant position on the PREDICT Executive.
We are inviting nominations from Research Assistants across PREDICT who will then be selected by the existing Executive.

To be eligible,  you need to be an existing PREDICT member.
Nominations are open until 18th of February 2022 at this stage (will be extended if needed).

If you wish to nominate yourself please email Catherine.wilson@mcri.edu.au, with the following details:

Your title and name

– Your craft group and current position held

– The primary organisation you work with

– The state you are based in

– Please write a brief description of why you wish to be part of the PREDICT Executive and what skills you bring.

– Please attach a brief CV

Taking part in the PREDICT Executive involves:

  • Attending approximately 13 meetings during the year via Zoom or potentially face to face for some meetings depending on the pandemic.  See current meeting schedule attached, we realise you may not be able to attend all meetings and the schedule may be updated during the year – depending on travel restrictions etc.
  • Previewing the executive agenda then actively participating in meetings to give an independent opinion/ advice.
  • Bringing issues of importance to the network, to the meeting agenda for discussion
  • Reviewing and commenting on new studies when they are presented to the Executive
  • Following up on actions deemed necessary at the meetings.
  • Reviewing and commenting on issues via email / telephone in between meetings as required.
  • Helping to develop and then reinforce PREDICT research guidelines and policy with members locally
  • Maintaining confidentiality in relation to sensitive issues discussed
  • Being involved with the PREDICT members meeting upon request

 

Please feel free to contact Catherine.wilson@mcri.edu.au if you have any questions or wish to discuss involvement in anyway (best to email me and we can set up a quick zoom!).

 

 

Project Snapshot – SONIC study

Study of Neck Injury Imaging in Children (SONIC): Improving the Diagnosis of Spinal Cord, Bone and Ligament Injuries

Many children sustain head and neck trauma during their lifetime. Significant neck injuries – to spinal cord, neck bones and connecting ligaments – can be identified by performing neck imaging with x-rays, or, if needed, computed tomography or magnetic resonance imaging. Yet, it is unclear which children should receive neck imaging in the emergency department (ED), especially in the context of increasing concerns about radiation-induced cancer in children and the discomfort and delays of immobilisation prior to imaging.

This study aims to:

(i) investigate the accuracy of existing neck injury clinical decision rules (CDRs) to detect neck injuries in children (external validation) of adult focussed CDRs and the newly developed paediatric PECARN CDR
(ii) derive and validate a new CDR for neck imaging in children (the SONIC CDR),
(iii) assess the cost implications of different CDRs in children.
(iv) investigate the epidemiology of cervical spine injuries in ANZ.

Study details:
News:

Recruitment has commenced at 5 Australian sites (Royal Children’s Hospital, Melbourne, Queensland Children’s Hospital, Perth Children’s Hospital, Perth, Women’s and Children’s Hospital, Adelaide and Darwin Hospital, NT, with over 300 patients enrolled.  Governance approvals are underway for the remaining 8 sites with hope to commence recruitment at these in the first half of 2022.

New!  Head Injury Guideline Algorithm Video

Dear PREDICT members,

We are pleased to let you know that a new video has been developed to accompany the PREDICT Australian and New Zealand Guideline for Mild to Moderate Head injuries in Children Algorithm, which outlines the key Imaging and Observation Decision-Making recommendations and how to use the algorithm in your clinical decision -making. It is now available to view on the PREDICT website at: https://www.predict.org.au/head-injury-guideline/dftb-education-modules/

This is in addition to the education modules developed by DFTB.